WORKPLACE SAFETY AND INSURANCE BOARD
APPEALS RESOLUTION OFFICER DECISION
DECISION Number: 20150002
DECISION DATE: March 11, 2015
OBJECTING PARTY: Worker
REPRESENTED by: Worker Representative
RESPONDENT: Employer (Not Participating)
HEARING: Hearing in Writing
HEARD By: P. Dardarian, Appeals Resolution Officer
ISSUES
Denial of initial entitlement for compression fractures at the T12 and L1 vertebrae.
Denial of loss of earnings (LOE) benefits from July 14, 2014 on the basis of suitable modified work.
Denial of LOE benefits from August 5, 2014 on the basis of a full recovery from the work-injury.
BACKGROUND
On May 8, 2014 this then 57 year-old Truck Driver reported that while he was driving his truck he went over a bump on a road and his seat went in the air. His seat then lost its air and bottomed out causing a jerking sensation to the worker’s low back. When he parked his truck at the yard, he bent over to get his gear and the tightness in his low back progressed to pain. Initial entitlement for a low back strain was allowed.
Case Manager’s Decisions
On July 9, 2014 the Case Manager (CM) concluded that it was expected that the worker would make a full recovery from his low back strain by August 5, 2014.
On July 17, 2014 the CM concluded that the modified work that was available at the employer from July 14, 2014 was suitable. As this would have restored the worker’s pre-injury wages, his LOE benefits were closed.
On August 25, 2014 the CM determined that the diagnosis of an anterior wedge compression fracture at T12 and L1 was not compatible with the mechanisms of his work-injury.
The Worker’s Position
Entitlement for the compression fractures ought to be allowed as the worker’s doctor of 30 years provided a medical report and opinion that the compression fractures were a direct result of his work-injury. As the worker had work-related compression fractures, he had ongoing back problems and is entitled to LOE benefits from July 14, 2014.
AUTHORITY
The following Operational Policies apply:
11-01-01 Adjudicative Process
18-03-02 Payment and Reviewing LOE Benefits (Prior to Final Review)
11-01-05 Determining Maximum Medical Recovery (MMR) (for decisions made before November 1, 2014)
ANALYSIS
1. Denial of initial entitlement for compression fractures at the T12 and L1 vertebrae.
I find that the worker’s T12 and L1 compression fractures are not the result of his May 8, 2014 work-injury. Policy 11-01-01 requires compatibility of a diagnosis to an accident history, and I do not find that such compatibility was met.
On August 22, 2014 a Medical Consultant (MC) reviewed this file to provide an opinion on this issue. The review demonstrated that the MC had a good understanding of the accident history and the medical reports/investigations that were available at that time.
The MC noted that an August 10, 2014 MRI revealed anterior wedge compression fractures at T12 and L1 that reduced vertebral body height by 45 % and 50 % respectively. The MC also noted that there was a previous May 12, 2014 lumbosacral X-ray that did not identify the presence of T12 or L1 compressions. Had these levels been visualized and the fractures not detected; the MC stated that the fractures would not have been present at the time of the X-ray.
The MC opined that the force of spinal impact on the date of injury was not sufficient to cause a compression fracture and that the T12 and L1 compression fractures were not related to the mechanisms of the accident history.
On November 24, 2014 the worker’s family doctor provided a contrary medical opinion. The doctor stated that the worker had not complained of prior back pain or discomfort. The doctor opined that the T12 and L1 compression fractures were directly related to the accident history. The doctor explained that the worker’s body raised when he went over the bump and as the seat was broken, he came back down with a lot of pressure and this caused the fractures.
While recognizing that a bone mineral density scan revealed that the worker had low Vitamin D levels, the doctor advised that the work-injury caused the fractures.
There were two contrary medical opinions. While I have consideration for the opinon that was provided by the worker’s doctor of over 30 years, for the reasons below, I do not find the facts of this case would support the doctor’s conclusions.
The University of Maryland Medical Centre website, www.umm.edo, states in part:
…compression fractures of the spine usually occur at the bottom part of the thoracic spine (T11 and T12) and the first vertebra of the lumbar spine (L1)...A common cause of compression fractures is the disease osteoporosis. This disease thins the bones, often to the point that they are too weak to bear normal pressure. The thinning bones can collapse during normal activity, leading to a spinal compression fracture. In fact, spinal compression fractures are the most common type of osteoporotic fractures… Trauma to the spinal vertebrae can also lead to minor or severe fractures. Such trauma could come from a fall, a forceful jump, a car accident, or any event that stresses the spine past its breaking point… If the fracture is caused by a sudden, forceful injury, you will probably feel severe pain in your back, legs, and arms. You might also feel weakness or numbness in these areas if the fracture injures the nerves of the spine… If a fracture is thought to exist, an X-ray of the spine will generally confirm its presence.
Had the accident history caused the worker’s compression fractures, I find it very likely that the worker would have had more pain than what was documented in the file and he would have obtained earlier medical attention. Although the accident occurred on May 8, 2014, the worker did not get any medical attention until four days later on May 12, 2014. At that time the worker went to a Walk-In-Clinic and complained of back pain. He was diagnosed with a sprain/strain injury and referred for an X-ray.
As documented above, the May 12, 2014 X-ray report did not identify a compression fracture. Although the X-ray report did not specify which levels of his spine were visualized; I find it very likely that had the worker complained to the doctor of pain to the areas of his T-12 and L1 vertebrae, these levels would have been visualized.
After the worker had his August 2014 MRI scan he was referred for a bone mineral density scan on August 26, 2014 and he was diagnosed with having osteoporosis. The worker was then assessed by a specialist in the fields of internal medicine and rheumatology, Dr. Shaikh, on October 27, 2014.
The report demonstrated that the specialist had a good understanding of the accident history, the initial complaints of low back pain, the May 2014 X-ray report, and the August 2014 MRI scan reporting a T12 and L1 compression fracture. The specialist also reviewed the bone density scan that confirmed that the worker had osteoporosis and a Vitamin D insufficiency.
Following a physical examination, the specialist clearly outlined that the worker was diagnosed with “…compression fractures secondary to osteoporosis.” Medication for osteoporosis and Vitamin D insufficiency were prescribed. When assessed on November 3, 2014 for his first Prolia injection, the specialist reported that the worker had severe osteoporosis.
I find that the worker’s compression fractures of his T12 and L1 vertebrae were the result of his osteoporosis and were not causally related to his work-injury.
2. Denial of LOE benefits from July 14, 2014 on the basis of suitable modified work.
3. Denial of LOE benefits from August 5, 2014 on the basis of a full recovery from the work-injury.
I find that the worker is not entitled to LOE benefits beyond July 14, 2014. Policy 18-03-02 states that LOE benefits can be paid if a work-injury prevents a worker from returning to any type of work. Policy 11-01-05 states that MMR is reached when a worker makes a full recovery from his work-injury.
Following his initial treatment, the worker was assessed by a Low Back Expert Physician (LBEP) on July 7, 2014. At that time the worker reported that he had attended an Emergency Department “…on a couple of occasions” as a result of cardiac and chest pains. With respect to his work-injury, the worker reported that he “…felt close to perfect 2 days ago.”
The doctor advised the worker that his low back examination was essentially normal and that the prognosis for a full recovery was good. The worker reported that there were not any modified duties available at the workplace and the doctor prognosticated that the worker would make a full recovery with a return to pre-injury job duties by August 5, 2014.
On July 9, 2014 the LBPE spoke to the worker’s family doctor and it was reported that the family doctor was in complete agreement with LBPE’s findings and recommendations.
On July 10, 2014 a Return to Work Specialist (RTWS) contacted the workplace parties to arrange an appointment to provide assistance in having the worker return to modified duties. On this same date, the worker attended an Emergency Department for a psychological issue. The worker was diagnosed with having “…anxiety, rule out PTSD”, was prescribed medication, was referred for a psychiatric assessment, and was authorized off of work.
On July 11, 2014 the RTWS met with the workplace parties. The employer had available the following alternate work:
Monitoring the gate entrance to the yard and the yard via security cameras or looking out the window. The worker will be set up in office/room and has ability to sit/stand or alternate positions while doing this task.
As the worker did not return to these alternate duties, the CM closed his LOE benefits.
I recognize that there were July 30, 2014 and August 11, 2014 medical reports from a physiotherapist that stated that as a result of the severity of the worker’s low back symptoms and range of motion limitations, he should remain off of work. However, these reports were greatly contradicted by the earlier July 9, 2014 LBPE report that stated that the worker’s low back examination was essentially normal. The physiotherapist’s reports were at about the same time that the worker’s T12 and L1 compression fractures were diagnosed and I find that this could account for the differing medical opinions.
As of July 14, 2014 I do not find the work-injury strain prevented the worker from doing any type of work. As the employer provided the worker with suitable alternate work that would not have resulted in a wage loss, he is not entitled to LOE benefits beyond this date. As prognosticated by the LBPE, I also find that the worker made a full recovery from his work-injury strain and reached MMR on August 5, 2014. Any ongoing back impairment beyond this date is the result of non-occupational impairments and not his work-injury.
CONCLUSION
The objections are denied.
The denial of initial entitlement for compression fractures at the T12 and L1 vertebrae is confirmed.
The denial of LOE benefits from July 14, 2014 on the basis of suitable modified work is confirmed.
The denial of LOE benefits from August 5, 2014 on the basis that the worker made a full recovery from the work-injury is confirmed.
DATED March 11, 2015
P. Dardarian
Appeals Resolution Officer
Appeals Services Division